Individual
MS. KIMBERLY LORENE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
1125 SKYLINE DR, CONWAY, AR 72032-6657
(501) 358-6120
(501) 358-6268
Mailing address
1125 SKYLINE DR, CONWAY, AR 72032-2857
(501) 358-6120
(501) 358-6268
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A03482 ANP
AR
Other
Enumeration date
02/24/2011
Last updated
05/10/2017
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